NCG170422_COMPLETE FILE - HISTORICAL_20150828

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
Iv 7D�{a-a.
DOC TYPE
EZ HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ Q 01 5 a 9 a g
YYYYMMDD

Central Files: APS ____ SWP
8/27/2015
Permit Number NCG170422 Permit Tracking Slip
Program Category Status Project Type
NPDES SW In review New Project
Permit Type Version Permit Classification
Textile Mill Products Stormwater Discharge CDC COC
Primary Reviewer Permit Contact Affiliation
bill.diuguid '
RECEIVEDCoastal
SWRuIe
AUG 2 8..2015
Permitted Flow
CENTRAL FILES
DWR SECTION
Facility
Facility Name
Major/Minor
Region
Homwood, Inc.'
Minor
Fayetteville
Location Address
County
766 Halleys Ferry Rd
Anson
Facility Contact Affiliation
Lilesville NC 28091 Chuck Home
766 Hailays Ferry Rd
Owner Lilesville NC 28091
Owner Name Owner Type
Homwood Inc Non -Government
Owner Affiliation
Chuck Home
766 Haileys Ferry Rd
Dates/Events Lilesville NC 28091
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue
Effective
Expiration
6/8/2015
�p
v llw-
0J Z--,[
Regulated Activities
Requested /Received Events
Textile manufacturing
RO staff report received
8/26115
RO staff report requested
815115
Outfall 1
Waterbody Name Streamindex Number Current Class Subbasin
Hale Creek 1342-3 C 03-07-17

ICDETIR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
August 27, 2015
Mr. Chuck Horne, President
Hornwood, Inc.
766 Haileys Ferry Road
Lilesville, North Carolina 28091
Subject: General Permit No. NCG170000
Hornwood, Inc.
COC No. NCG170422
Anson County
Dear Mr. Horne:
In accordance with your application for a discharge permit received on June 8, 2015, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state -
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual
permit application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the
Division of Energy, Mineral and Land Resources (Division). The Division may require modification or
revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division or permits required by
the Division of Water Resources, Coastal Area Management Act or any other federal, state or local
governmental permit that may be required.
If you have any questions concerning this permit, please contact Bill Diuguid, Stormwater
Program Planner at telephone number [phone].
Sincerely,
1':�2- JLe'
for Tracy E. Davis, A.E., CPM, Director
Division of Energy, Mineral and
Land Resources
cc: Fayetteville Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section - Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 I FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: hft :ll ortal.nodenr.or tweb4r/
An Equal Opportunity 1 Affirmative Action Employer —.50% Recycled 110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG170000
CERTIFICATE OF COVERAGE No. NCG170422
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Hornwood, Inc,
is hereby authorized to discharge stormwater from a facility located at
Hornwood, Inc.
766 Haileys Ferry Road
Lilesville
Anson County
to receiving waters designated as an unnamed tributary to Hale Creek, a Class C waterbody to Yadkin-PeeDee River
Basin; in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1,
I1, III, IV, V and VI of General Permit No. NCG 170000, as attached.
This Certificate of Coverage shall become effective August 27, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 27, 2015.
Tor -Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission

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FACILITY LOCATION TOPOGRAPHICAL MAP
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O001/2015 10:50 FAX [phone] Conversion Technology
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A7,60k
Division of Enemy, Mineral, and Land Resources
......Oft Land Quality Section
NCDENRNational Pollutant Discharge Elimination System
Now- EcRomr-oW oW
4haomrorr,wo WOW. Rmou.ae
NCG170000
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under
NCG170000:
STORMWATER DISCHARGES associated with activities classified as:
SIC' 22 Textile Mill Products
And, I ilra arthritipq rlApmpd by DEMLR to be Similar in the process, or the
materials, products, by-products, or waste materials.
Mfg rr FIWfrgjWIdF.
IM"Imi Y!w5i fARMA
* standard Industrial Classification Code
(Please print or type)
1) Mailing address of owner/operator (address to which official permit correspondence will be mailed):
Name ChuSk Hgrn�
Street Address 766 Halleys Ferry Road
City Loilesvll4e StateNC— ZIP Code S� 091
Telephone No. (704) -4121_ Fax. [phone]_ _.
E-mail address churn D hora)yoodi
2) Location of facility producing discharge:
Facility Name Hornwood. Inc..
Facility Contact _$Qnny S rr
Street Address 766 Haileys Fer[Y Road
City Lileisville State N_C-_ ZIP Code gA021
County Anpon
Telephone No. (704) 48 8-4121 Fax: [phone], _
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Traveling we t on wLay 74turn right out onto
Haile s Ferry Road. The facillty_is Ig 1r�1H I�ley's FX[y Road on the rig -hi about Q.6-miles- r-orr Hwy 74.
(A copy of a County map or USG8 quad shaet with laolllty clearly located on the map is required to be submitted with tills application)
4) Latitude 34° 57' 14"_ Longitude D* 57' 28" _ _ (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility
R1 Existing
B) Standard Industrial Classification:
Date operation is to begin
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facfiity
SIC Code: -2- -2-- 5 e_
sq. 7 9 1,57 � "' '_2
Page 1 of 4
Last revised 7/2114
SWU 232-110210

NCG170000 N.O.I.
7) Provide a brief narrative description of the types of Industrial activities and products manufactured at
this facility: Hornwood. Inc. produces rolls of fabric woven from various textiles. Some of these fabrics are
coated and colored.
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 1
9) Receiving waters:
What is the name of the body or bodies of water,(creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Hale Creek *j2&P W - f�ae b.•.e 03 - 07- 17 eL ss c
s'T k- . .T O DOE h' r 3 -1fL- 3
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). NIA
10) Does this facility have any other water quality permits?
0 No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
0 No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
0 Yes
If yes, please briefly describe: The majority of materials at the facility are stored under cover. Most areas of
the facility that are not impervious are grass. The facility also uses rip rap to prevent erosion in areas prone to
erosion.
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
0 Yes
If yes, when was it implemented?1998
14) Are vehicle maintenance activities occurring at this facility?
0 No ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
0 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
0 No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
ONO ❑ Yes
Page 2 of 4
SWU-232-110210 Last revised 8/11/14

NCG170000 N.O.I.
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored: _
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor: _
Vendor address:
16) Certification:
North Carolina General Statute 143-215.6 b (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report,
plan or other document filed or required to be maintained under Article 21 or regulations of the Environmental
Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate any
recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the
Environmental Management Commission Implementing that Article, shall be guilty of a misdemeanor punishable by a
fine not to exceed $10,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides
a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both, for a similar offense.)
I hereby request coverage under the referenced General Permit. I understand that coverage under this
permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as
an individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Per on Signing: 6azlL NpAre
Title: C4"rt
(Signature of Applicant)
G
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00 made payable to
NCDENR.
Final Checklist
This application will be returned as Incomplete unless all of the following items have been Included.
Please do not ask us to hold an Incomplete application In anticipation of a check under separate cover.
❑ Check for $100 made payable to NCDENR
❑ This completed application, signed by the owner/operator, and all supporting documents
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map
Mall the entire package to:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note: The submission of this document does not guarantee the issuance of an NPDES permit.
Page 3 of 4
SWU-232-110210 Last revised 8/11/14

RECENEDIDENRJDWR
71 WaterQualitvRefta
AOperationsSeft
nCD� FayBtteville Regional CMa6
E�'*R�
North Carolina Department of Environment and N5tural Resources
Pat McCrory Donald R. van der Vaart
Governor -- Secretary_
August 27, 2015 f
Mr. Chuck Horne, President 1
Hornwood, Inc. } SEP 1 8 2015
766 Haileys Ferry Road
Lilesville, North Carolina 28091
Subject: General Permit No. NCG170000
Hornwood, Inc.
COC No. NCG170422
Anson County
Dear Mr. Horne:
In accordance with your application for a discharge permit received on June 8, 2015, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state -
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual
permit application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the
Division of Energy, Mineral and Land Resources (Division). The Division may require modification or
revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division or permits required by
the Division of Water Resources, Coastal Area Management Act or any other federal, state or local
governmental permit that may be required.
If you have any questions concerning this permit, please contact Bill Diuguid, Stormwater
Program Planner at telephone number [phone].
Sincerely,
ORIGINAL SIGNED B4
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and
Land Resources
cc: Fayetteville Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
Division of Energy, Mineral, and Land Resources
Energy section - Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: http://Dortal.ncdenr.o[gtwebAr/
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG170000
CERTIFICATE OF COVERAGE No. NCG170422
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Hornwood, Inc.
is hereby authorized to discharge stormwater from a facility located at
Hornwood, Inc.
766 Haileys Ferry Road
Lilesville
Anson County
to receiving waters designated as an unnamed tributary to Hale Creek, a Class C waterbody to Yadkin-PeeDee River
Basin; in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1,
I1, III, IV, V and VI of General Permit No. NCG 170000, as attached.
This Certificate of Coverage shall become effective August 27, 2015,
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 27, 2015.
ORIGINAL SIGNED M
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission

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HORNWOOD, INC.
ISO 9001 REGISTERED
June 1, 2015
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
RE: HORNWOOD, INC. FACILITY NOTICE OF INTENT UNDER NPDES
GENERAL PERMIT NCG170000
Dear Sir or Madam:
Please find enclosed the Notice of Intent for coverage under NPDES
General Permit NCG170000 for the Hornwood, Inc. facility located at 766
Haileys Ferry Road, Lilesville, NC 28091.
If you have any questions or require additional information, you can contact
either me at (704)-848-4121, or our environmental consultant Mr. Nash
Skipper of Conversion Technology, Inc. at (770)-263-6330, ext. 109, as he
prepared the NOI. Thank you for your assistance.
Sincerely,
& 42n�
Chuck Horne
President
Hornwood, Inc.
�19@ OM[
uu SUN 0 8.,,2015
766 Haileys Ferry Road, Lilesville, North Carolina 28091-9759,
Telephone: [phone], Fax: [phone]

COC # Facility Location City/County
NCG170422 Homewood Inc 766 Hai)eys Ferry Road Lilesville/Anson
If you need any more info, give me a call. If you could send me a recommendation to issue the permit by 09/05/2015,
I'd appreciate it, so I can issue their COC. I cannot issue the permit until the respective regional office reviews and
comments back to me with a recommendation to issue the permit.
Thanks.
Rill
Bill Diuguid
Stormwater Permitting Program
Land Quality Section
Division of Energy, Mineral and Land Resources I NCDENR
1612 Mail Service Center (Mail)
512 N. Salisbury St, Raleigh, NC 27604 1 9th Floor (Location & Parcels)
Raleigh North Carolina 27699-1612
Phone: [phone] Fax: [phone]
Website: htti)://portal.nedenr.org/web/wQ/ws/su
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties.

Lawyer, Mike
From:
Lawyer, Mike
Sent:
Wednesday, August 26, 2015 4:37 PM
To:
Diuguid, Bill
Cc:
LaBounty, Tim L
Subject:
RE: NCG170422 Homewood Inc Anson County NOI Aug 5 2015
Bill,
Tim and I conducted a site visit today at the subject facility, which is actually called Hornwood Inc. We met with Mr.
Benny Burr, Environmental Manager, to review the conditions/requirements of the NCG170000 permit and make
observations of site conditions. Although their NOI states one outfall, during our walk around the facility we discovered
two additional stormwater outfalls. We relayed to Mr. Burr that he would need to add these outfalls to his monitoring
schedule and update their site map. Mr. Burr was very appreciative of our time and assistance in coming out to the
facility and has a better understanding of the permit and monitoring requirements. Our office recommends proceeding
with issuance of permit coverage under the NCG170000 General Permit. Please provide our office with a copy of the
issuance letter and Certificate of Coverage.
If you have any questions or need any additional information about this facility, please contact me.
Thanks,
Mike
Michael Lawyer, CPSWQ
Environmental Program Consultant
NCDENR —Division of Energy, Mineral and Land Resources
Land Quality Section
Fayetteville Regional Office
P: [phone]
F: [phone]
e-mail: [e-mail]
E-mail correspondence to and from this address is subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulation.
From: Diuguid, Bill
Sent: Wednesday, August 05, 2015 1:14 PM
To: Cole, Brad; Lawyer, Mike
Subject: NCG170422 Homewood Inc Anson County NOI Aug 5 2015
Brad Cole, Mike Lawyer, Fayetteville Regional Office:
Please review the attached NOI application with the objective of responding to me with a recommendation to issue the
permit. I recognize that you may not visit each new permittee during this NOI review, but it affords you the opportunity
to log the permit into your regional database and add the facility to a future monitoring and compliance visit
schedule. Therefore, your recommendation now to issue the permit serves as your acknowledgement that (1) the
facility is located in your region, (2) that there are no current complaints outstanding about the facility that have not
been dealt with, and (3) that the facility may ultimately be inspected by the regional staff. I've also attached a scanned
copy of the NOI and a location map for your review.

06/01/2015 10-:50 FAX [phone] Conversion Technology
la002
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Dif E
vision onergyr Minors], and Land Resources
.
....r►W.r...�.. .Land
NCDEN!
Quality Section
National Pollutant Discharge Elimination System
*naoruv'r,w wuuLr�w�o
NCG170000
National Pollutant Discharge Elimination System application for coverage undo
NCG170000:
ATORMWATEW DISCHARGES sescolated with activities classified as:
SIC' 22 Textile Mill Products
And, 11160 DMIWIPa r1AAMAd by DEMLR to be similar in the process, or the
materials, products, by-products, or waste materials.
"titanderd Induatrlai.Classttl=10n Code
(PWSO print Of type)
1) Mailing address of ow6efloperator (address to which official permit correspondence will be mailed):
Name Chuck Horne
Street Address Mfi H
City yi 1 State lg - ZIP,Code 2
Telephone No. (7 ,;,4121, Fax: U-04) Sq( •4as5
t-n1ai! address o 1hom ham�eioadinC.com
2) Location of facility producing discharge:
Facility Name
Facilitj Contact
Street Address
City
CcUrity
Telephone No.
ligO&M, Inc.
Ag-n—ny BUrr
7 .Haileyg Ferry Road _
UgfiAl1State NQ ZIP Code 2809i
-QA) 94&4121
3) Physical Location Information:
Fax: Ct04) M-45 ,{�
Please provide a narrative description. of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway Intersection). Traygling.wett on Nidhway 7 L UM1right {auth)_onto
Hai s Fer •I ty is tq�t d on dal.1%4gon th ti
(A'oopy of a eountypap or USGS quad $heat with tadity'dwdy loomed an"m is moored io tie submitted with thin eppricaw)
4) tatituds Longitude ' (degrees, minutes, seconds)
5) This NPDES Penmlt Application applies to which of the following
:0 New or Proposed Facility
B( Existing
6) Standard Industrial Classification:
Daie operation is to begin
Provide 'the.4 digit Standard Industriai Classification Code (SIC Code) that describes the primary Industrial
aotivlty;at this facility
,SIC Code: 2.,. :.
Page 1 of 4
$M-232-116210 'Lastrevbed 7/W 14

y
NCG170000 N.O.I.
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: !Jgrnwood, Inc.r u s rolls f fabric woven from various textiles, Some f - hese fabrics are
,oatedand colored.
8) Discharge points / Receiving waters:.
How many -discharge points (ditches, pipes, channels, etc:).convey stormwater from the property? 1
9) Receiving,.waters:
What is the name of the body or bodies of water,(creek; stream, river, lake, etc.) that the facility.stormwater
discharges end up in? Halp Creek V A j2K, h-.e 03 - 07— / 7 CLA rr C
ST6-. �r fjA_M. 113—YZ_ 3
li the„site stormwater discharges to a separate storm sewer system,: hame the operator of the separate storm
sewer system (e.g. City.of Raleigh municipal storm sewer). N/A
10) Does this facility -have any other water quality permits?
0 No
❑ Yes
If yes, fist the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
0 No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
(3 No
0 Yes
If'yes, please briefly describe: The matority_of materials at the facility are stored under cover. Most areas of
the_facility that are not imoenrious_are grass, The facility also uses rip -ray to prevent erosion in areas row. ne to
erosion,
13) Does this facllity have:a Stormwater Poffution:Prbventlon Plan?
Ci. No
0 Yes
If yes, when was it implemented?J9$
14) Are vehicle maintenance actlyltles.occurring at this: facility?
lid No ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
0 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than'1.000 kg. of hazardous waste generated per month) of
hazardous waste?
0 No ❑ Yes
c) le1his facility -a,Large Quantity Generator (1000.kg. or more of hazardous waste generated per month) of
hazardous waste?
QNo ❑ Yes
Page 2 of 4
SwU-232,110216 Last revised 8111/14

E
NOW 70000 N.O.I.
d) If you answered yes to questions b. or c., please provide thefollowing information:
Types) of waste:
Flow is material stored:
Where=is material stored:
How -many disposal shipments per year:
Name of transports disposal vendor:
Vendor address:
16) Certification:
North Carolina General,Statute.143-215.6 b (1) provides that:
Any'person who knowingly makes any false statement, representation, or certification in any application; record, report,
plan or other document filed or required 4o be maintained under Article 21 or regulations of the Environmental
Management Commission implementing that Article, or who falsifies„tampers with or knowingly renders inaccurate any
recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the
Environmental Management Commission Implementing that Article; shall be,guilty of a m€sdameanor punishsbfe by. a.
,fine not to exceed $10,000, or byImprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides
a punlshment by a fine of not mor6;than! $10,000"or imprisonment riot more than 5 years, or both, for a similar offense.}
I hereby request coverage under the:referenced General Permit. I understand that coverage under this
permit will constitute the permit requirements for the discharge(s) and.is enforceable in the same manner as
,an individual permit.
I cer0ifythat„1 am familiar with the information contained in this application and that,to the best of my
knowledge and belief such information is°true, complete, and accurate.
Printed Name of Peron Signing: u CzkgAte
Title:
(Signature of Applicant)
G -.1 Ls�
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.60 made payable to
NCDENR.
Final Checklist,
This appilcation will be returned as incomplete unless all of the following items have been Included.
.Please do not,ask us to hold an--fncompletb3 application in anticipation of a check,under separate cover.
❑ Check for $100'made payable to NCDEN R
❑ This completed application, signed by the owner/operator, an4all supporting documents
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map
Mall.the,entire package to:
Stormwater F''ermitting Program.
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note: The submission of this document does, not guarantee the Issuance of an -AtPPE$ Permit..
Page 3 of 4
SWU-232-110210 Last revised 8111/14

4;
HORNWOOD, INC.
ISO 9001 REGISTERED
June 1, 2015
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612Wail Service-
.Center
Raleigh., North Carolina 27699-1612
RE: HORNWOOD, ::INC. FACILITY NOTICE OF INTENT UNDER NPDES
GENERAL PERMIT NCG17a000
Dear Sir or Madam:
Please:: find enclosed the Notice: of Intent for coverage under NPDES
General Permit, NGG1700c0 for the Hornwood., Inc. facility located at 766
Haileys Ferry. Road, Lilesville, NC 28091.
Ifyou have any questions or require additional information, you can contact
either me at (744)-848-4121 or our environmental consultant Mr. Nash
Skipper of Conversion Technology, Inc. at '(770y263-6330, ext. 109, as he
prepared the NOI. Thank you for your assistance.
Sincerely,
Chuck Horne
President
Hornwood, Inc,
,"
766 Haileys Ferry Road, Lilesville, North,Carolina 28091-9759,
Telephone: (704)=8484121, Fax: [phone]
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